2 Masoud R. Manaviat, M.D. June 2011 Aging and the eyeMasoud R. Manaviat, M.D.June 2011
3 The Challenges of Aging – How older patients are different from all other patients As people age, some physiologic changes are inevitableOther changes, while not universal, are far more common than among younger peopleOlder people also face unique psycho-social challengesThese changes and challenges can lead to a variety of geriatric syndromes and issuesThese in turn can lead to poor health outcomes, functional decline, frailty, disability and dependence
4 Physiologic Changes Associated with Aging Examples of universal changesDecreased night visionDecreased muscle massLoss of hair pigmentDecreased lung vital capacityDecreased heightDecreased gait speed
5 Physiologic Changes Associated with Aging Examples of changes (including diseases) that are increasingly common, though not inevitable, as people ageHearing lossMacular degenerationHypertensionHeart diseaseCancerParkinson’s diseaseDementia
6 Social Problems More Common with Aging Loss of incomeLoss of close familyLoss of communitySocial isolation
8 The Challenges of an Aging Population – Why it matters In the 2000 US Census, 12.5% of the US population was >64By 2030, it is predicted that 20% of the US population will be >64As the elderly population increases the care needs and expenditures for that care will increaseThe geriatric workforce is not predicted to increase to meet this demand
9 Sensory Impairment - Vision Visual impairment affects 20-30% of people over the age of 75.Visual impairments that occur with greater frequency as people age includeRefractive errorCataractsGlaucomaMacular degenerationDiabetic retinopathyBlindness
10 Age-Dependent Changes: Physiological and Performance
12 General Aging Changes Mostly affect appearance Seldom affect performanceSome need monitoring with ageLensAqueous HumorRetinaMacula
13 General Aging Changes Sclera- thinner, pigment change Aqueous Humor- intraocular pressure Vitreous Humor- thins, opacity Cornea- arcus senilis (Ca and cholesterol), sensitivity Iris- muscles weaken, smaller pupilLens size and thickness , elasticity Conjunctiva- dry eye
14 More General Aging Changes! Retina- dulls, blood vessel changesOptic Nerve- boundaries less defined, fewer capillariesMacula- little or no foveal reflex, drusen and lipofuscin deposits, pigmentation Lids- orbicularis oculi muscle weakensLacrimal Glands/Tears- production , Orbit- fat loss, enophthalmos
15 Age Changes in Performance Refraction- lens and ciliary musclesResults in PresbyopiaAge 40+Acuity and ContrastDecreases after age 50Due to BrainGlare Due to lens and vitreous humorDarkPupil and Lens
16 More Performance Changes! Fun stuff- Vitreous Humor?HazinessFlashing LightsMoving SpotsColorDiscrimination as cones DarkPupil and LensVisual FieldSize 1 to 3 degrees per decade
17 Diseases and Syndromes Age-Related Changes:Diseases and Syndromes
22 CataractWhat is it?Clouding of the eye’s lens that causes loss of vision.
23 Who is at higher risk? Most cataract are related to aging (continued from previous slide)Who is at higher risk?Most cataract are related to agingOther risk factorsDiabetesSmokingExposure to sunlight
24 CataractNormal visionSame scene as viewed by a person with cataract
25 Cataract Symptoms Cloudy or blurred vision. Colors that may not appear as bright as they once did.Glare.Poor night vision.
26 Treatment options Glasses Better lighting Surgery (continued from previous slide)Treatment optionsGlassesBetter lightingSurgery
27 Cataract What can you do? Eat a healthy diet. Wear sunglasses and a brimmed hat when outdoors.Don’t smoke.
29 GlaucomaWhat is it?A group of eye diseases that can damage the optic nerve in the eye.Glaucoma can develop in one or both eyes.Primary open-angle glaucoma is the most common form.
30 Who is at higher risk? African Americans over age 40. (continued from previous slide)Who is at higher risk?African Americans over age 40.Everyone over the age of 60, especially Mexican Americans.People with a family history of glaucoma.
31 GlaucomaNormal visionSame scene as viewed by a person with glaucoma
32 Glaucoma Symptoms Treatment options No early warning signs or symptoms No painLoss of side visionTreatment optionsMedications, usually eye dropsLaser or conventional surgery
33 Glaucoma What can you do? People at higher risk should get a comprehensive dilated eye exam every one to two years or as instructed by your eye care professional.
35 Age-Related Macular Degeneration (AMD) What is it?Common among people aged 60 or older.Can damage the macula, which is needed for sharp, detailed central vision.
36 Who is at higher risk? The greatest risk factor is age. (continued from previous slide)Who is at higher risk?The greatest risk factor is age.Other risk factorsSmoking.Family history.Obesity.Race. Caucasians are more likely to lose vision from AMD.
37 Age-Related Macular Degeneration (AMD) Normal visionSame scene as viewed by a person with AMD
38 AMD Symptoms No pain. Blurred vision. Drusen (can only be seen by an eye care professional).
39 (continued from previous slide) Treatment optionsAge-Related Eye Disease Study (AREDS) special vitamins/minerals supplement formulation.Laser surgery.Eye injections.Photodynamic therapy.
40 AMD What can you do? Eat a healthy diet Don’t smoke, or stop smoking Maintain normal blood pressureMaintain a healthy weightExercise
42 Diabetic Eye Disease What is it? A group of eye problems associated with diabetes.Diabetic retinopathy is a leading cause of vision loss and blindness.
43 Who is at higher risk? People with diabetes. (continued from previous slide)Who is at higher risk?People with diabetes.The longer someone has diabetes, the more likely it is he or she will get diabetic retinopathy.
44 Diabetic Retinopathy Normal vision Same scene as viewed by a person with diabetic retinopathy
45 Diabetic Eye Disease Symptoms No early warning signs or symptomsEarly detection and timely treatment can reduce the risk of vision loss.Treatment optionsLaser treatmentSurgery
46 Diabetic Eye Disease What can you do? Control your ABCs - A1C, blood pressure, and cholesterol.Take your medications as directed.Maintain a healthy weight.Exercise.Don’t smoke.Have a dilated eye exam at least once a year.
47 Dry Eye What is it? The eye does not produce tears properly. Tears evaporate too quickly.Inflammation of the surface of the eye may occur along with dry eye.
48 Who is at higher risk? Women often experience dry eye more than men. (continued from previous slide)Who is at higher risk?Women often experience dry eye more than men.Dry eye can occur at any age.Older adults frequently experience dryness of the eyes.
49 Dry Eye Symptoms Stinging or burning of the eye. Feeling as if sand or grit is in the eye.Episodes of excess tears following dry eye periods.A stringy discharge from the eye.Pain and redness of the eye.Episodes of blurred vision.
50 Symptoms Heavy eyelids. (continued from previous slide)SymptomsHeavy eyelids.Decreased tearing or inability to shed tears when crying.Uncomfortable contact lenses.Decreased tolerance to any activity that requires prolonged visual attention.Eye fatigue.
51 (continued from previous slide) Treatment optionsUsing artificial tears, prescription eye drops, gels, gel inserts, and ointments.Wearing glasses or sunglasses.Getting punctal plugs.
52 Dry Eye What can you do? Use an air cleaner to filter dust Avoid dry conditionsUse lubricating eye dropsVisit an eye care professional
55 Low VisionWhat is it?A visual impairment that is not corrected by standard eyeglasses, contact lenses, medication, or surgery.It interferes with the ability to perform everyday activities.
56 Who is at higher risk? People with eye disease. (continued from previous slide)Who is at higher risk?People with eye disease.Some people develop vision loss after eye injuries or from birth defects.
57 Low Vision Treatment options What can you do? Vision rehabilitation. See a specialist in low vision.Talk to your eye care professional about vision rehabilitation.Use low vision devices.